内侧胭绳肌延长术对双侧痉挛性脑瘫下肢肌肉长度的影响

Gait analysis for medial hamstring lengthening in spastic diplegia

目的观察内侧胭绳肌延长术对双测痉挛性脑瘫下肢肌肉长度的影响。方法将双测痉挛性脑瘫患者分为两组，一组为髂腰肌组5例（10侧肢体），即内侧胭绳肌延长，股直肌远端转位加髂腰肌延长术。另一组为非髂腰肌组5例（10侧肢体），即内侧胭绳肌延长，股直肌远端转位术。利用计算机模拟骨肌肉步态模型技术，选择性计算术后下肢相关肌肉的肌肉长度，并对比分析。结果髂腰肌组中患者的股二头肌长头肌肉长度，在步态周期中的平均值、最小值和总长度分别为0．5000±0．0080、0．4800±0．0059、50．8600±0．8084，明显长于非髂腰肌组患者（P〈0．05）。股二头肌短头肌肉长度最小值在步态周期中所出现的时间（81．6700±4．3221）％GC，较非髂腰肌组患者（75．1300±1．8851）％GC明显延迟（P〈0．01），半腱肌和半膜肌肌肉长度最小值在步态周期中出现的时间分别为（72．6700±3．0768）％GC和（73．0000±3．6332）％GC，较非髂腰肌组出现的时间（68．500±1．5119）％GC和（68．1300±1．5526）％GC明显延迟（P〈0．05）。结论屈髋肌挛缩组患者在施行内侧胭绳肌延长、股直肌远端转位和髂腰肌延长术后，出现胭绳肌功能不全模型的原因，是由于外侧胭绳肌肌肉长度较长和内侧胭绳肌肌肉长度相对较长。

Objective To evaluate the effects of medial hamstring lengthening on gait in patient with diplegic cerebral palsy by instrumented gait analysis and computer simulation. Methods A group of patients who underwent medial hamstring lengthening and distal rectus transfer was compared to a group of patients who underwent intramuscular psaos lengthening. Results There was no significant difference between the two groups in the psaos lengths. The mean value of the postoperative biceps femoris long head muscle length in the psaos group was 0. 500 ± 0.008. The sum value was 50.8600 ± 0.8084 and minimum value was 0.4800 ± 0. 0059. They were all significantly longer than those in the non-psaos group （ P 〈 0.05）. The onset time of minimal length of biceps femoris short head in the gait cycle was 81.67% GC ± 4.3221% GC. It was significantly longer than that in non-psaos group （ P 〈 0.01 ）. The onset of minimal length of medial hamstrings muscle was significantly delayed compared to the non-psaos group. The onset of minimum lengths in semitendinosus and simimembranosus was （72. 6700 ± 3. 0768 ）% GC and （73. 0000 ±3.6332）% GC in psaos group,while（68. 5000 ± 1. 5119）% GC and（68. 1300 ± 1. 5526）% GC in non -psaos group,respectively. Conclusion These results documented the ＂hamstring insufficiency pattern＂ after combined hamstrings and psaos lengthening. Assessment of lower extremity muscles completely is important in diplegic cerebral palsy in the presence of hip flexor tightness.